Transaxillary versus transfemoral access as default access in TAVI: A propensity matched analysis

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Surgical Access Techniques

Background:

• Transfemoral (TF) access is the standard for transcatheter aortic valve implantation (TAVI).
• Transaxillary (TAx) access is an alternative for patients with difficult iliofemoral anatomy.
• The comparative safety and efficacy of TAx as a preferred access route in TAVI remain unclear.

Purpose of the Study:

• To compare clinical outcomes between TAVI patients using TAx as preferred access versus TF access.
• To evaluate the safety and efficacy of TAx versus TF access in a large, propensity score-matched cohort.

Main Methods:

• A retrospective analysis compared a single-center TAx cohort (354 patients) with a multi-center TF cohort (5980 patients).
• Propensity score matching created comparable groups of 322 patients each.
• Clinical outcomes were assessed using Valve Academic Research Consortium-2 (VARC-2) criteria.

Main Results:

• Matched cohorts showed similar 30-day and one-year all-cause mortality between TAx and TF groups (5% vs 6% at 30 days; 20% vs 16% at 1 year).
• Myocardial infarction rates were higher with TAx access (4% vs 1%, p=0.05).
• New permanent pacemaker implantation rates were lower with TAx access (12% vs 21%, p=0.001).

Conclusions:

• Transaxillary (TAx) access is a feasible and safe primary approach for TAVI.
• TAx access demonstrates comparable safety and efficacy to traditional transfemoral (TF) access.
• TAx access may offer advantages, such as reduced need for permanent pacemakers.